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Take home messages by Dr. John M. Barry
2023 Kimbrough at Tucson, AZ:

Many thanks to Dr. Barry for taking the time to make this contribution.

  • Tucson can be cold in January.
  • It’s controversial to biopsy a testis during a microdissection testicular sperm extraction (m-TESE) in men with non-obstructive azoospermia.
  • Now that the world’s population is 8 billion, is third party insurance coverage for assisted reproduction at risk?
  • In boys less than 10 years of age, there is no difference in testicular volume between the side of a hydrocele and the contralateral side.
  • REZUM water vapor thermal therapy for surgical management of benign prostates over 80 grams, the current cut-off, is possible - and successful.
  • Surgeons are clueless about the costs of disposable surgical items. (Third Place, Residents Competition)
  • Multiparametric MRI may be a substitute for a renal biopsy to diagnosis clear cell renal carcinoma in cT1a renal masses.
  • Microwave ablation is as effective as partial nephrectomy for small renal masses.
  • Perhaps incidentally discovered cT1a renal masses should be left alone until they grow or become symptomatic.
  • Sub-cuff urethral atrophy in a patient with an artificial urinary sphincter responds to cuff replacement, usually down-sized by 0.5 cm.  If this occurs after 3 years, it’s best to replace the entire device, not just the cuff.
  • Near-infrared fluorescence imaging (Firefly technology) allows precise real-time visualization of vascular perfusion during reconstructive surgery.
  • Don’t use a buccal mucosa tube graft to repair a ureteral defect; it will fail.
  • When a simple sentence, “Urology or endocrinology consultation recommended,” was added to CT reports of adrenal incidentalomas, it resulted in clinician adherence to the guideline recommendation by the American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons: Do a biochemical evaluation of incidentally discovered adrenal masses. (Second Place, Residents Competition)
  • Perhaps a voided urine test, like ExosomeDx Prostate Intelliscore (EPI), will allow primary care practitioners to skip the DRE when screening men for prostate cancer.
  • A relatively high proportion of men assigned to active surveillance for prostate cancer don’t make follow-up appointments. They need to be tracked down and reminded.
  • Pure microscopic gonadoblastoma is rare in an otherwise normal (XY) male; so rare that treatment guidelines haven’t been developed.
  • Why isn’t serum prostatic acid phosphatase used as a biomarker for Sipuleucel-T (Provenge) response?
  • Perhaps 5-alpha reductase inhibitors do prevent the development of significant prostate cancer.
  • There seems to be conflicting information about major cardiovascular event (MACE) risks after treatment with GnRH agonists versus GnRH antagonists.
  • Are the harms of current ADT such that we should re-explore the use of low dose estrogen therapy?
  • Low-intensity extracorporeal shockwave, stem cell, and platelet-rich plasma therapies for ED; do they really work? Let’s use mercury strain gauge recordings of nocturnal erections - rather than questionnaires - and find out.
  • Robotic-assisted peritoneal flap pull-through vaginoplasty for male-to-female gender-affirming surgery is best viewed on a video presentation before doing one.
  • One cannot label the military as “conservative” when the topic is gender-affirming surgery. Well-done.
  • HoLEP for BPH didn’t result in an increase in urinary incontinence or bother in 73 patients.
  • HoLEP prostatectomy started with an early apical release and anterior dissection is a good idea.
  • When using a gelatin plug for hemostasis at the conclusion of a percutaneous nephrostolithotomy, dip it in contrast agent for easy identification on concurrent or later x-rays.
  • If a course in leadership is offered, take it.
  • The history of male urinary incontinence treatment is fascinating.
  • Risk-aligned surveillance forms for patients with non-muscle invasive bladder cancer are a promising strategy for compliance with AUA guidelines.
  • Variant histology should result in mentally upstaging a non-muscle invasive bladder cancer.
  • Perhaps split dosing protocols for BCG are unnecessarily compromised by the requirement that unused product be discarded after 2 hours. Rumor has it that it is viable for 72 hours, and that 1/3 of a usual BCG dose can be effective.
  • African American men are more likely to undergo radiation treatment for prostate cancer than non-African American men. Why?
  • Therapeutic radiation cures cancer, but with time, debilitating pelvic organ toxicity can develop. Patient acceptance of palliative surgery is often delayed.
  • Make friends with a medical oncologist; the -ides, -nibs and -mabs for our cancers are becoming TNTC.
  • An ERG inhibitor, salt derivative 7b, selectively inhibits ERG-positive prostate cancer cells. The development of ERG inhibitors may benefit patients with ERG-positive prostate cancer. (Best of Poster Session)
  • In a pregnant woman, an absent ureteral flow-related artifact on a T-2 weighted single shot fast spin-echo MRI (SSFSE) will document ureteral obstruction, retroperitoneal edema and hydronephrosis from a stone when compared with the contralateral side. (First Place, Residents Competition)
  • Genito-pelvic dysesthesia in women is a fascinating topic.
  • Trazadone has caused clitoral priapism.
  • A new urethral stricture scoring system, Length, Location and Etiology, may help us evaluate treatment options and guide treatment recommendations.
  • Uroflometry by cellphone app is a good idea.
  • The GU Bowl is great fun.